Improved clinical outcomes of patients with cirrhosis and acute variceal bleeding over the last two decades.

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2025-05-03 DOI:10.1016/j.gie.2025.04.045

Nikolaus Pfisterer, Florian Riedl, Michael Schwarz, Benedikt Simbrunner, Nina Dominik, Georg Kramer, Mathias Jachs, Lukas Hartl, Florian Putre, Lukas Ritt, Mattias Mandorfer, Philipp Holzmueller, Christian Madl, Michael Trauner, Thomas Reiberger

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引用次数: 0

Abstract

Background and aims: Acute variceal bleeding (AVB), a severe complication of portal hypertension, may cause death in patients with cirrhosis. We investigated whether outcomes after AVB have improved over time.

Methods: Data from 406 patients with cirrhosis with AVB (2000-2022) from two Viennese centers were analyzed for recurrent bleeding, 6-week mortality, and 1-year transplant-free survival (TFS).

Results: Recurrent bleeding rates within 6 weeks decreased from 19.4% to 11.8% (HR:0.59, 95%CI: 0.35-0.97;p=0.049) and bleeding-related mortality decreased from 23.6% to 18.3% (HR:0.68, 95%CI: 0.44-1.06;p=0.099). 1-year TFS after AVB improved from 63.8% to 73.7% (HR:0.68; 95%CI: 0.47-0.97;p=0.041). Higher Child-Pugh scores were associated with increased risk for bleeding (aOR:1.68) and mortality (aOR:1.69, both p<0.001). Non-selective beta-blockers reduced 1-year mortality risk (aOR:0.48,p0.038).

Conclusion: Recurrent bleeding and mortality rates after AVB improved over the last two decades but remain substantial, highlighting the need for continued efforts to optimize outcomes for patients with cirrhosis.

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改善肝硬化和急性静脉曲张出血患者的临床结果在过去的二十年。

背景和目的：急性静脉曲张出血（AVB）是门脉高压的严重并发症，可导致肝硬化患者死亡。我们调查了AVB后的结果是否随着时间的推移而改善。方法：分析来自维也纳两个中心的406例肝硬化合并AVB患者（2000-2022）的复发性出血、6周死亡率和1年无移植生存期（TFS）的数据。结果：6周内出血复发率由19.4%降至11.8% (HR:0.59, 95%CI: 0.35 ~ 0.97;p=0.049)，出血相关死亡率由23.6%降至18.3% （HR:0.68, 95%CI: 0.44 ~ 1.06;p=0.099）。AVB后1年TFS从63.8%提高到73.7% (HR:0.68；95%置信区间:0.47—-0.97;p = 0.041)。较高的Child-Pugh评分与出血风险（aOR:1.68）和死亡率（aOR:1.69）增加相关。结论：AVB后复发性出血和死亡率在过去二十年中有所改善，但仍然很大，强调需要继续努力优化肝硬化患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.